First Fluconazole-resistant Candida auris isolated from fungal otitis in Iran

Abstract

Background and Purpose: Candida auris, as a new characterized pathogenic yeast,has attracted remarkable attention in the recent decade due to its rapid global emergence and multidrug resistance traits. This unique species is able to cause nosocomial outbreaks and tolerate adverse conditions; however, it has been mostly misidentified by conventional methods.
 Case report: This report aimed to describe the first fluconazole-resistant case of C.auris otitis in an immunocompetent patient in Iran. The isolate showed minimum inhibitory concentration of ≥ 32 μg/ml for fluconazole; however, the patient was treated with topical clotrimazole and miconazole with no recurrence.
 Conclusion: This was the second strain of C. auris isolated from otitis in Iran which was fluconazole-resistant, unlike the first Iranian isolate.

Diagnostic Allele-Specific PCR for the Identification of Candida auris Clades

“…Clade typing can be of significant epidemiological value, as it provides information on the origin of a strain and can help to monitor nosocomial transmission. Moreover, clade diagnosis can have a clinical value, as clade-associated virulence and resistance implications have been reported [ 2 , 3 , 12 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 52 ]. Identification of the clade to which C. auris isolates could belong in an outbreak might, thus, have implications for the choice of treatment and the use of infection control and prevention measures.…”

“…In scientific research, clade identification is also essential. Molecular and pharmaceutical research of C. auris implies the use of isolates from different clades due to the outspoken phenotypic difference between clades and the possible implications for scientific conclusions on a species level [ 2 , 3 , 17 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 30 , 52 ]. Another useful purpose of screening isolates with this diagnostic AS-PCR assay is the potential to identify new clades.…”

“…For the identification of C. auris clades, a 212–214 bp ITS alignment was created that contained 121 sequences: 96 typed C. auris strains from clade I, II, III, and IV as reported by Vatanshenassan et al [ 31 ] (NCBI GenBank accessions MN242989–MN243084), two Iranian clade V strains [ 21 , 22 ] (NCBI GenBank accessions: MW019910.1 and MZ389242), and 23 C. auris strains from an in-house collection of isolates from all five clades. The latter consists of 15 clade I strains, three clade III strains, three clade IV strains, one clade II strain, and one clade V strain and includes at least one typed strain per clade for which whole-genome sequencing data are available (e.g., clade I: B8441, clade II: B11220, clade III: B11221, clade IV: B11244 [ 2 , 3 , 13 , 17 ], and clade V [ 12 ]: B18474/IFRC2087; see GenBank accessions PRJNA328792 and PRJNA541007, respectively).…”

“… UPGMA dendrogram of a 248–251 bp ITS alignment of sequences of 121 C. auris strains: 96 typed strains from four clades [ 31 ] and three clade V strains [ 12 , 21 , 22 ], represented by their GenBank accessions, and 23 strains from our in-house collection, represented by the numbers 1 to 23 (see Table A2 ). Four ITS-based clusters are shown: clades I and III, clade II, clade IV, and clade V. The scale bar represents the percentage of nucleotide variation.…”

“…Moreover, specific drug resistance-associated mutations have been associated with specific clades [ 2 ]. Clade II and V are not associated with hospital outbreaks and commonly cause ear infections, while fungemia is rare [ 12 , 17 , 20 , 21 , 22 ]. Other studies suggest that clade II isolates are more susceptible to disinfection methods [ 23 , 24 , 25 ].…”